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The combination of the microscopic examination of the peripheral blood and analysis of the lymphocytes by [[flow cytometry]] to confirm clonality and marker molecule expression is needed to establish the diagnosis of CLL. Both are easily accomplished on a small amount of blood. A [[flow cytometer]] instrument can examine the expression of molecules on individual cells in fluids. This requires the use of specific antibodies to marker molecules, with fluorescent tags recognized by the instrument.{{citation needed|date=April 2022}} |
The combination of the microscopic examination of the peripheral blood and analysis of the lymphocytes by [[flow cytometry]] to confirm clonality and marker molecule expression is needed to establish the diagnosis of CLL. Both are easily accomplished on a small amount of blood. A [[flow cytometer]] instrument can examine the expression of molecules on individual cells in fluids. This requires the use of specific antibodies to marker molecules, with fluorescent tags recognized by the instrument.{{citation needed|date=April 2022}} |
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In CLL, the lymphocytes are all genetically identical since they are derived from the same B cell lineage, expressing common B-cell markers CD19 and CD20, with abnormal expression of surface markers CD5 and CD23.<ref name="Strati2018" /> These B cells resemble normal lymphocytes under the microscope, although slightly smaller, and are fragile when smeared onto a glass slide, giving rise to many broken cells, which are called "smudge" or "smear" cells and can indicate the presence of the disease.<ref name="isbn1-4051-4265-0">{{cite book|author=Bain, Barbara J.|url=https://archive.org/details/bloodcellspracti00bain|title=Blood Cells: A Practical Guide|publisher=Blackwell Publishing Limited|year=2006|isbn=978-1-4051-4265-6|page=[https://archive.org/details/bloodcellspracti00bain/page/n449 439]|url-access=limited}}</ref> Smudge cells are due to cancer cells lacking in [[vimentin]], a type of [[cytoskeleton]] proteins which is a structural component in a cell which maintains the cell's internal shape and mechanical resilience).<ref name="Wintrobe">{{cite book|title=Wintrobe's clinical hematology|date=2014|publisher=Lippincott Williams & Wilkins|isbn=978-1451172683|editor1-last=Greer|editor1-first=John P.|edition=Thirteenth|editor2-last=Arber|editor2-first=Daniel A.|editor3-last=Glader|editor3-first=Bertil|editor4-last=List|editor4-first=Alan F.|editor5-last=Means Jr.|editor5-first=Robert T.|editor6-last=Paraskevas|editor6-first=Frixos|editor7-last=Rodgers|editor7-first=George M.|editor8-last=Foerster|editor8-first=John|name-list-style=vanc}}</ref>{{rp|1899}}<ref>{{cite journal|vauthors=Patteson AE, Carroll RJ, Iwamoto DV, Janmey PA|date=December 2020|title=The vimentin cytoskeleton: when polymer physics meets cell biology|journal=Physical Biology|volume=18|issue=1|pages=011001|doi=10.1088/1478-3975/abbcc2 |
In CLL, the lymphocytes are all genetically identical since they are derived from the same B cell lineage, expressing common B-cell markers CD19 and CD20, with abnormal expression of surface markers CD5 and CD23.<ref name="Strati2018" /> These B cells resemble normal lymphocytes under the microscope, although slightly smaller, and are fragile when smeared onto a glass slide, giving rise to many broken cells, which are called "smudge" or "smear" cells and can indicate the presence of the disease.<ref name="isbn1-4051-4265-0">{{cite book|author=Bain, Barbara J.|url=https://archive.org/details/bloodcellspracti00bain|title=Blood Cells: A Practical Guide|publisher=Blackwell Publishing Limited|year=2006|isbn=978-1-4051-4265-6|page=[https://archive.org/details/bloodcellspracti00bain/page/n449 439]|url-access=limited}}</ref> Smudge cells are due to cancer cells lacking in [[vimentin]], a type of [[cytoskeleton]] proteins which is a structural component in a cell which maintains the cell's internal shape and mechanical resilience).<ref name="Wintrobe">{{cite book|title=Wintrobe's clinical hematology|date=2014|publisher=Lippincott Williams & Wilkins|isbn=978-1451172683|editor1-last=Greer|editor1-first=John P.|edition=Thirteenth|editor2-last=Arber|editor2-first=Daniel A.|editor3-last=Glader|editor3-first=Bertil|editor4-last=List|editor4-first=Alan F.|editor5-last=Means Jr.|editor5-first=Robert T.|editor6-last=Paraskevas|editor6-first=Frixos|editor7-last=Rodgers|editor7-first=George M.|editor8-last=Foerster|editor8-first=John|name-list-style=vanc}}</ref>{{rp|1899}}<ref>{{cite journal|vauthors=Patteson AE, Carroll RJ, Iwamoto DV, Janmey PA|date=December 2020|title=The vimentin cytoskeleton: when polymer physics meets cell biology|journal=Physical Biology|volume=18|issue=1|pages=011001|doi=10.1088/1478-3975/abbcc2|pmid=32992303}}</ref>[[File:Smear cells.jpg|thumb|right|Smudge cells in peripheral blood]] |
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=== Surface markers === |
=== Surface markers === |
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